Ultrasound-guided peripheral nerve block

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Sonography guided femoral nerve block. Fermoral nerve block.jpg
Sonography guided femoral nerve block.

Ultrasound-guided peripheral nerve block is a procedure used in anesthesia that allows real-time imaging of the positions of the targeted nerve, needle, and surrounding vasculature and other anatomic structures. [1] This visual aid increases the success rate of the block and may reduce the risk of complications. [2] [3] It may also reduce the amount of local anesthetic requried, [4] while reducing the onset time of blocks. [5]

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Postoperative residual curarization (PORC) or residual neuromuscular blockade (RNMB) is a residual paresis after emergence from general anesthesia that may occur with the use of neuromuscular-blocking drugs. Today residual neuromuscular blockade is defined as a train of four ratio of less than 0.9 when measuring the response to ulnar nerve stimulation at the adductor pollicis muscle using mechanomyography or electromyography. A meta-analysis reported that the incidence of residual neuromuscular paralysis was 41% in patients receiving intermediate neuromuscular blocking agents during anaesthesia. It is possible that > 100,000 patients annually in the USA alone, are at risk of adverse events associated with undetected residual neuromuscular blockade. Neuromuscular function monitoring and the use of the appropriate dosage of sugammadex to reverse blockade produced by rocuronium can reduce the incidence of postoperative residual curarization. In this study, with usual care group receiving reversal with neostigmine resulted in a residual blockade rate of 43%.

Local anesthetic nerve block

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References

  1. Brull, Richard; Perlas, Anahi; Chan, Vincent W. S. (16 April 2007). "Ultrasound-guided peripheral nerve blockade". Current Pain and Headache Reports. 11 (1): 25–32. doi:10.1007/s11916-007-0018-6. PMID   17214918.
  2. Chin, Ki Jinn; Chan, Vincent (October 2008). "Ultrasound-guided peripheral nerve blockade". Current Opinion in Anesthesiology. 21 (5): 624–631. doi:10.1097/ACO.0b013e32830815d1. PMID   18784490.
  3. Guay, Joanne; Suresh, Santhanam; Kopp, Sandra (2019-02-27). "The use of ultrasound guidance for perioperative neuraxial and peripheral nerve blocks in children". The Cochrane Database of Systematic Reviews. 2: CD011436. doi:10.1002/14651858.CD011436.pub3. ISSN   1469-493X. PMC   6395955 . PMID   30820938.
  4. Koscielniak-Nielsen, Zbigniew J.; Dahl, Jörgen B. (April 2012). "Ultrasound-guided peripheral nerve blockade of the upper extremity". Current Opinion in Anesthesiology. 25 (2): 253–259. doi:10.1097/ACO.0b013e32835069c2. PMID   22246462.
  5. Lewis, Sharon R.; Price, Anastasia; Walker, Kevin J.; McGrattan, Ken; Smith, Andrew F. (2015-09-11). "Ultrasound guidance for upper and lower limb blocks". The Cochrane Database of Systematic Reviews (9): CD006459. doi:10.1002/14651858.CD006459.pub3. ISSN   1469-493X. PMC   6465072 . PMID   26361135.